Certificate of Insurance Attachment

CERTIFICATE OF INSURANCE ATTACHMENT

This Certificate of Insurance Attachment (the Attachment) is entered into between Contractor Name: with principal address: (hereinafter "Contractor") and Obligee Name: with principal address: (hereinafter "Obligee"), effective as of Contract Date: .

RECITALS

WHEREAS, Obligee requires proof of insurance and certain endorsements as a condition to entering into or continuing the Contract referenced above; and

WHEREAS, Contractor represents that Contractor and its insurers will provide, maintain and deliver the insurance coverages, limits, endorsements and evidence of insurance described in this Attachment for the duration required by the Contract; and

WHEREAS, the parties desire to set forth the specific insurance requirements and evidentiary documentation to be attached to and incorporated into the Contract.

NOW, THEREFORE, in consideration of the mutual covenants set forth herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this Attachment, the following terms have the meanings set forth below. "Certificate" means a certificate of insurance and any required endorsements completing the evidence of insurance. "Policy" means an insurance policy issued by an insurer described in Section 7. "Project" means:

2. INSURANCE COVERAGES AND MINIMUM LIMITS

Contractor shall procure and maintain the following insurance coverages, at minimum limits not less than those stated below, unless a different limit is expressly approved in writing by Obligee:

a) Commercial General Liability — Each Occurrence: $; General Aggregate: $.

b) Automobile Liability — Combined Single Limit: $ covering all owned, hired and non-owned vehicles used in connection with the Contract.

c) Workers' Compensation and Employers' Liability — Statutory workers' compensation limits with Employers' Liability limits of at least $.

d) Professional Liability (if applicable) — Per Claim: $; Aggregate: $.

e) Umbrella/Excess Liability — Each Occurrence/Aggregate: $, providing excess coverage over the primary policies required herein.

Unless otherwise agreed in writing, deductibles and self-insured retentions shall not exceed $ without Obligee's prior written consent, which consent shall not be unreasonably withheld.

3. EVIDENCE OF INSURANCE; REQUIRED ENDORSEMENTS

Prior to commencement of work and at each policy renewal, Contractor shall deliver to Obligee a Certificate and the following endorsements, each endorsed to the applicable Policy where available:

- Additional Insured endorsement naming Obligee as additional insured on Commercial General Liability, written as: .

- Waiver of Subrogation in favor of Obligee on Workers' Compensation and General Liability: Waiver required

- Primary and Non-Contributory endorsement stating that Contractor's insurance is primary and non-contributory to any insurance maintained by Obligee: Required

The Certificate must reference the Contract or Project and show Policy Numbers, Policy Effective Date: and Policy Expiration Date: for each policy listed below.

4. POLICY IDENTIFICATION

Producer/Agent: | Contact:

Insurer A (General Liability): Policy No.:

Insurer B (Automobile Liability): Policy No.:

Insurer C (Workers' Compensation): Policy No.:

Insurer D (Professional/Umbrella): Policy No.:

5. ADDITIONAL INSURED / WAIVER / PRIMARY COVERAGE

Contractor's Commercial General Liability policy must include an endorsement naming Obligee, its officers, directors, employees and agents as additional insureds to the extent required by the Contract and for ongoing operations, completed operations, and products liability where applicable. Select applicable endorsement options:

Additional Insured — Ongoing Operations

Additional Insured — Completed Operations

Where required, Contractor shall obtain and maintain a Waiver of Subrogation in favor of Obligee on Workers' Compensation and General Liability policies, and the Contractor's policies shall be primary and non-contributory to any insurance available to Obligee.

6. NOTICE OF CANCELLATION OR MATERIAL CHANGE

Coverages required by this Attachment shall not be canceled, materially reduced, or materially changed without thirty (30) days' prior written notice to Obligee, except when cancellation for non-payment of premium where ten (10) days' notice shall be provided, if allowed by the Policy. Notice shall be provided to:

7. INSURER QUALIFICATIONS

All insurers providing the required coverages must be licensed to do business in the jurisdiction of the Project and possess an A.M. Best rating of at least A- VII or otherwise acceptable to Obligee in writing. Contractor shall supply such documentation of financial capacity as Obligee may reasonably request.

8. CERTIFICATIONS AND REPRESENTATIONS

By signing below, Contractor certifies that the information provided on the Certificate and in this Attachment is accurate and that the required insurance policies are in force as stated. Contractor further represents that it will maintain the required insurance in full force for the duration of the obligations under the Contract and will promptly furnish renewal Certificates and endorsements evidencing continued compliance.

9. FAILURE TO MAINTAIN INSURANCE

If Contractor fails to procure or maintain insurance as required, Obligee may procure such insurance and charge Contractor for the cost, or pursue any other remedy available under the Contract or at law. Procurement of insurance by Obligee shall not be deemed a waiver of Contractor's obligations under this Attachment or the Contract.

10. MISCELLANEOUS PROVISIONS

Governing Law: This Attachment shall be governed by and construed in accordance with the laws of the state of: without regard to its principles of conflict of laws.

Entire Agreement: This Attachment, together with the Certificate and required endorsements, constitutes the entire agreement between the parties with respect to insurance requirements and supersedes all prior negotiations, representations or agreements, whether written or oral.

Severability: If any provision of this Attachment is determined to be invalid or unenforceable, such determination shall not affect the remaining provisions which shall continue in full force and effect.

Amendments and Waiver: No amendment, modification or waiver of any provision of this Attachment shall be effective unless in writing and signed by both parties.

Counterparts: This Attachment may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

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